Renal Malacoplakia Reappraised

Dobyan, Dennis C.; Truong, Luan D.; Eknoyan, Garabed

doi:10.1016/s0272-6386(12)70313-x

Cited by 71 publications

(78 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Michealis-Guttman bodies, a pathognomonic feature of renal malakoplakia, are never seen in any other condition including granulomatous pyelitis; furthermore, malakoplakia usually involves the renal parenchyma rather than the renal pelvis. 16,18,19 Necrotizing granulomatous inflammation and pyelocalyceal dilatation are seen in both renal tuberculosis and granulomatous pyelitis; however, renal tuberculosis is characterized by granulomatous inflammation involving predominantly the renal parenchyma, and much less frequently affecting the pyelocalyceal system; other characteristic features of renal tuberculosis including simultaneous active infection of lung or other genitourinary organs, frequent bilateral renal involvement, and positive acid fast bacilli by special stains or culture should be definitive. 16 Fungal infection of the kidney is almost always limited to immunosuppressed patients, with renal involvement reminiscent of acute pyelonephritis rather than granulomatous inflammation; it is associated with abundant organisms detected by special stains, but prominant pyelocalyceal involvement or urinary tract obstruction is not features of renal fungal infection.…”

Section: Discussionmentioning

confidence: 99%

Granulomatous pyelitis associated with urinary obstruction: a comprehensive clinicopathologic study

et al. 2006

View full text Add to dashboard Cite

Urinary obstruction is rarely associated with a distinct granulomatous inflammation, which involves the pyelocalyceal system and closely simulates infectious conditions including tuberculosis. Its clinicopathologic features, however, have not been adequately studied since there are only seven isolated reported cases. In a comprehensive study of 112 kidney specimens with urinary obstruction, we identified five cases of granulomatous pyelitis. The features of these cases were detailed and compared with the previously reported cases. Among the five identified subjects, three patients had history of urolithiasis and two had ureteral stenosis and all had stent placement 7 weeks to 12 years before nephrectomy for relief of the unilateral urinary obstruction. The age distribution was between 38 and 81 years. Two had end-stage renal disease or chronic renal failure. The pyelocaliceal system showed frank hydronephrosis (1 case) or partial dilatation (4 cases) and contained cheesy and gritty material in its lumen. Each case showed severe granulomatous inflammation, which was limited to the pelvic wall and closely associated with calcified debris, necrotic inflammatory cells, and material consistent with Tamm-Horsfall protein. The kidney showed chronic tubulointerstitial nephritis but without granulomas. Cultures of urine, blood, and the renal pelvic content, and special stains of tissue sections did not show fungi or mycobacteria in any case. Many of these features were also observed in previously reported cases. Granulomatous pyelitis is a rare but distinct cliniocopathologic entity characterized by severe noninfectious granulomatous inflammation limited to the renal pelvis, which is uniformely asociated with urinary obstruction and pyelocalyceal dilatation and may develop in response to accumulated calcified material in the renal pelvis. Awareness of this entity and its characteristic clinicopathologic features also helps eliminate an infectious etiology with obvious treatment and prognostic implications. Keywords: urinary obstruction; granulomatous inflammation of kidney; granulomatous pyelitis; lithiasis; mycobacteria; fungus Chronic urinary obstruction causes characteristic changes of the pyelocalyceal system and the kidney. The pyelocalyceal system shows dilatation, intact urothelium with reactive atypia, active inflammation of its wall, and thickening of its muscularis. The kidney changes include tubular atrophy, interstitial fibrosis, and active interstitial inflammation, but the glomeruli and blood vessels are intact. The end result is variable loss of renal parenchyma. These changes are often so characteristic that a diagnosis of obstructive uropathy can be readily made in a nephrectomy specimen without knowledge of the clinical condition of urinary obstruction. 1 Urinary obstruction, however, rarely does not induce the characteristic changes described above, but is associated with a distinct granulomatous inflammation, which involves the pyelocalyceal system and closely simulates infectious conditions, for whic...

show abstract

Section: Discussionmentioning

confidence: 99%

Granulomatous pyelitis associated with urinary obstruction: a comprehensive clinicopathologic study

et al. 2006

View full text Add to dashboard Cite

show abstract

“…11,15 The kidney is involved in approximately 15% of cases, with 75% of these affecting women. 5,15 Fine needle aspiration (FNA) diagnosis of malacoplakia has been reported for the thyroid, 7 gastrointestinal tract, 1,9 skin, 4 vagina, 14 pelvis, 12 prostate, 3,13 lymph nodes 8 and lung. 16 To our knowledge this is the first report of renal malacoplakia diagnosed by fine needle aspiration.…”

mentioning

confidence: 99%

Diagnosis of Renal Malacoplakia by Fine Needle Aspiration Cytology

Kapasi

Robertson²,

Futter³

1998

Acta Cytologica

View full text Add to dashboard Cite

“…As many authors agree there is a decreased intra cellular cGMP/cAMP ratio that seems to diminish capacity of macrophages for bacterial lysis. Hence, in Malacoplakia the assumption exists that the underlying cellular defect is the impaired intracellular killing of bacteria [169,170]. The most frequent bacteria associated with malacoplakia are coliforms that in 75% of cases is E. coli [169].…”

Section: Pathogenesismentioning

confidence: 99%

“…For the malacoplakia in the urinary tract, the female to male ratio is 4:1; however, this ratio does not stand for other body tissues [168,169]. The affected patients who are mostly debilitated, are immunosuppressed, with other chronic diseases and they are similar to those patients on long-term steroid administration and individuals with acquired immunodeficiency syndrome, lymphoma, and diabetes mellitus [168].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The affected patients who are mostly debilitated, are immunosuppressed, with other chronic diseases and they are similar to those patients on long-term steroid administration and individuals with acquired immunodeficiency syndrome, lymphoma, and diabetes mellitus [168]. Malacoplakia could appear through various clinical presentations that is appropriate to the location of the disease-associated plaques and can involve any portion of the urinary tract, nonetheless, the bladder is the most commonly involved site and it is followed by the renal parenchyma, ureters, and renal pelvis [168,169]. The symptoms for the bladder malacoplakia that is more common than the other types of urinary tract involvement are bladder irritability and hematuria.…”

Section: Clinical Presentationmentioning

confidence: 99%

See 1 more Smart Citation